Facelift

Providing Facelift Surgery near Manchester, New Hampshire

The term “facelift” is a misnomer, because the operation actually tightens the cheeks and neck, rather than the entire face.

As we age, a number of things happen in differing amounts and at different rates in each of us. How fast these aging changes appear depend upon heredity, sun exposure, lifestyle, diet, smoking, and skin care, and include: sagging of the cheek fat from the mid-cheek toward the upper lip, producing skin adjacent to the upper lip; relaxation of cheek skin producing “jowls” along the jawline just below the corners of the mouth; the development of “marionette lines,” or vertical lines running from the corners of the mouth toward the jawline, produced by a ligament that attaches the skin to the underlying bone; increasing laxity of the neck skin; accumulation of fat in the front of the neck; and the appearance of ridges or “bands” that run from beneath the chin toward the collar bones, one on each side of the windpipe. Each of these aging changes needs to be diagnosed and treated individually and in varying amounts. Some patients need all of them treated; some, only a few. That is why facelift surgery at our New Hampshire practice, between Manchester and the Massachusetts border, is tailored to the individual patient, addressing the specific problems that he or she is concerned with.

In order to treat all of the problems listed above, the surgeon must make a small incision in the crease underneath the chin (in order to remove fat from the front of the neck and tighten the muscles that create the neck bands mentioned above); and an incision in front of each ear (where the ear joins the cheek) that runs around the earlobe, behind the ear where it joins the side of the head. This incision location leaves all scars well camouflaged, even for patients who like to wear their hair pulled back, because no scars cross the lower skin behind the ear. In front of the ear, the scars run into the sideburns so that, as the cheek skin is pulled upward, the sideburn does not rise higher and higher, one telltale sign of a prior facelift. Because these scars are hidden in normal expression lines or places where one expects to see shadows, and ordinarily heal well, becoming thin and white (although still permanent); most patients have little trouble concealing them.

Facelift is an outpatient operation. No hair is shaved, and any drains and dressings are removed in the office after 24 – 48 hours. Sutures are removed between the 7th and 10th days. Most patients look presentable after two weeks, but improvement, as with any surgical procedure, progresses more and more over the ensuing months.

Because a facelift corrects aging changes only in the cheeks and neck, there are procedures for smoothing the forehead and elevating the eyebrows if necessary. These procedures are ordinarily performed through incisions in the scalp or at the front of the hairline. The operation, called a “brow lift” is designed to achieve three goals: To elevate the brows if they have begun to sag; to reduce frown lines between the eyebrows; and to reduce transverse forehead creases. The brow lift can be performed by itself or in conjunction with a facelift at our practice, south of Manchester, New Hampshire, near the Massachusetts border, and does not prolong the recovery.

Because a facelift corrects aging changes only in the cheeks and neck, there are procedures for smoothing the forehead and elevating the eyebrows if necessary. These procedures are ordinarily performed through incisions in the scalp or at the front of the hairline. The operation, called a “brow lift” is designed to achieve three goals: To elevate the brows if they have begun to sag; to reduce frown lines between the eyebrows; and to reduce transverse forehead creases. The brow lift can be performed by itself or in conjunction with a facelift at our practice, south of Manchester, New Hampshire, near the Massachusetts border, and does not prolong the recovery.

Most facelift patients have only mild discomfort. The neck, where most of the tightening occurs, naturally feels snug after surgery, but any neck discomfort usually lasts only a few days. Most patients have mild forehead swelling (only if they have had a brow lift) and swelling of the cheeks and jowl areas, but ordinarily this is not uncomfortable. Most patients tell me that they take very little of their pain medication, although their friends and family may think that they look worse than they feel! For this reason, most of my patients plan to “hide out” at least for the first week after a facelift, and plan to limit their activities the following week, eliminating events where their appearance might be under close scrutiny.

For many years, the direction of “pull” (the direction in which the tissues were tightened) was backward toward the ear. Unfortunately, that is not the direction in which faces age, and often produces a “wind swept,” overdone facial appearance.

Gravity pulls facial tissues downward, and therefore the most logical facelift correction should be in an upward direction.

The “short scar facelift” encompasses a variety of techniques, but what is common to all is an upward pull. The direction of the pull shortens the scar and often makes it possible to have no scar behind the ear, only one in front of the ear just where the ear meets the cheek, and for a short distance around the sideburn.

In cases where the neck requires a great deal of work or there is much neck skin laxity, an incision behind the ear may also be necessary, but this is easy to camouflage.

Most short scar facelifts also involve tightening the tissues beneath the skin, not just pulling the skin tighter. However, short scar facelifts should not be confused with “lunchtime facelifts,” “weekend lifts,” “mini lifts,” or any of the like. Many of these are “quickie” procedures with little recovery but little improvement. The short scar facelift leaves less on the surface that can be seen, but the correction underneath is just as complete and anatomical.

I like the short scar facelift whenever I can use it because recovery is faster, and yet the result is even better than many traditional lifts could produce – the perfect combination for the modern, busy patient.

Additional Questions about Facelift Surgery

The following are some of the frequently asked questions we receive regarding facelift surgery at our New Hampshire practice, located between Manchester and Massachusetts in Nashua.

Absolutely not. In some parts of the country, and for some surgeons and patients, a very dramatic, artificial, or even somewhat bizarre appearance may be the goal, but for my patients, and in my opinion, that is neither natural nor desirable. The majority of my patients have an obvious facial improvement and achieve an improvement in all the areas that they dislike within the limits of what is safely surgically possible, and often return to work and their other activities only to find that their friends and acquaintances think they look better or rested but not different. For most of my facelift surgery patients, this is exactly what they prefer, and for me it indicates that we have achieved a very natural result. That is my goal.

Absolutely not. There are some surgeons who believe that it doesn’t make sense to rejuvenate only part of the face because that might create an incongruity of “young” areas next to “old” areas; but that argument has never completely made sense to me. Although the cheeks or neck can be smoothed or tightened and particular deformities like bands or jowls can be improved, we are naturally not creating “younger” from “older,” but only repositioning and smoothing what is there. If you have aging changes in all of these locations that bother you sufficiently, correcting everything at once makes sense. If not, I recommend that you only have the areas corrected that trouble you. This principle must be followed within reason, however, because it is possible to correct so little that the patient doesn’t achieve his or her goal. This is where a good consultation allows you and I to decide what ought to be treated and what is not necessary.

As a general principle, you should treat only what bothers you, but enough to accomplish your goals.

I like that operation for the right indications. There are patients, even younger individuals in their 20s or 30s, who have had a full, fatty, or loose neck since their teens or twenties, but don’t have wrinkling or looseness of the skin in the neck or cheeks. For these patients, there are two options, depending upon the severity of the problem. The first is a “submental lipectomy and platysmaplasty,” which means removal of fat in the neck, tightening the neck muscles, and freeing the skin over the front of the neck, all through a short incision in the crease under the chin. Assuming that the skin still has elasticity, these maneuvers allow the skin to tighten and improve the neckline without the necessity of scars in front of the ears.

The important thing to remember about this procedure is that no skin is removed, and so the entire quality of the result depends on how elastic the skin is: If it is loose and wrinkled, less will occur than if it is still youthful and firm. Secondly, the neck skin needs to be freed widely, even though the incision is relatively short. Like smoothing the wrinkles out of a tablecloth, you have to smooth the tablecloth all the way to the edges of the table. In this case, that means that the surgeon can’t only loosen the skin right in the front of the neck, but has to free it way out to the sides so that it will redrape and redistribute over the whole front of the neck, thereby giving as much improvement as possible.

You must also remember that the submental lipectomy/platysmaplasty does not make any changes above the jawline, so that jowling or cheek laxity will still remain. Even so, for some patients with limited aging changes confined to the neck, or for patients who wish only a modest change and a smaller procedure that does not improve the cheeks, the submental lipectomy may be sufficient. This is a shorter procedure that can be performed as an outpatient and has a quicker recovery than the facelift.

Blepharoplasty (eyelid surgery) is often performed at the same time as facelift or brow lift, and is discussed separately elsewhere on this website. Laser resurfacing (to smooth skin wrinkles) can also be performed, but should be staged after the facelift for safety.

Many patients who see looseness in their skin and come to inquire about facelift also have aging changes in the skin itself (freckling, age spots, lines, heavy pores, decreased “rosiness” or “freshness” in their complexions) and can benefit from our Skin Solutions skin care program (discussed in more detail in our section on Skin Solutions). When you come in for your consultation, you will be given a certificate for a complimentary MicroPeel. Most patients choose to begin the entire program, while others may choose to undergo other treatment options, such as BOTOX® Cosmetic or Restylane®.

Summary

When I first came to Nashua more than 36 years ago, the only thing that most physicians knew about plastic surgeons was that they performed facelifts. Even though the specialty covers many other kinds of surgery, facelifting is still an important part, and for the right patient, and in one of its many forms, can eliminate many of the unflattering changes that occur with aging without producing artificial or unnatural appearances.

Like any operation, facelifting is real surgery, and has possible, although infrequent, potential for complications (infection, unusual bleeding, nerve injury, or poor scarring) and these are discussed in detail at the time of your consultation. That is why a consultation is so important. It allows you and I to get to know each other, and it gives me an opportunity to find out what bothers you, so that the solution can be customized to produce the maximal improvement and achieve as many of your goals as possible, safely and in a manner that respects your priorities.

Fees

Because Dr. Constantian operates in a hospital setting, the hospital and anesthesia fees are not within his control and may change from time to time. If you would like more information regarding the hospital and anesthesia fees, please call our New Hampshire office.

Contact Our Practice, Serving Massachusetts and New Hampshire

If you are considering having a facelift, please contact our practice, conveniently located between Manchester, New Hampshire and the Massachusetts border. We will happily answer any questions you have, or help you schedule a consultation with Dr. Mark Constantian.